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<title>Documento sin t&iacute;tulo</title>
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    <td width="94%" height="66" valign="middle"> <p align="center"><strong><img src="logo.jpg" width="175" height="35"></strong></p>
      <blockquote> </p> 
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    <td width="6%" valign="middle"><strong><img src="image001.jpg" width="142" height="62"></strong></td>
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    <td colspan="2"><div align="center"><strong><font size="1" face="Verdana, Arial, Helvetica, sans-serif">IDCliente: 
        { % idcliente % }</font></strong></div></td>
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    <td colspan="2"><div align="center"><strong><font size="1" face="Verdana, Arial, Helvetica, sans-serif">Nombre 
        Participante:</font></strong><font size="1" face="Verdana, Arial, Helvetica, sans-serif"> 
        { % nombre % }</font> </div></td>
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    <td colspan="2"><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><strong>Direcci&oacute;n: 
        </strong>{ % direccion % } - <strong>Tel&eacute;fono:</strong> { % telefono 
        % }</font></div></td>
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    <td colspan="2"><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><strong>Fecha 
        Cup&oacute;n:</strong> { % fecha % } - <strong>Por un importe de: $</strong> 
        { % total % }</font></div></td>
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    <td colspan="2"><div align="center"></div></td>
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    <td colspan="2"><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif">Acepto 
        las bases y condiciones del concurso.</font></div></td>
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    <td colspan="2"><div align="center"><font size="1" face="Verdana, Arial, Helvetica, sans-serif">Firma:</font></div></td>
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